“When I first started this project, I really thought of medical marijuana as a joke,” he tells Fresh Air‘s Terry Gross.

But then the palliative care specialist began to look seriously into the issue, and his mind began to change: “I’ve come to realize there really are medical benefits to medical marijuana. … For many of the patients I spoke with, medical marijuana is not a joke. It’s not funny. It’s a treatment that they’ve come to rely on.”

While researching his new book, Stoned: A Doctor’s Case for Medical Marijuana, Casarett examined the limited medical studies related to the drug’s use, traveled to places where it is being used legally and tested it on himself. He also spoke to patients who had used the drug to treat a variety of ailments, including seizures, post-traumatic stress disorder and neuropathic pain.

The book lays out the case for marijuana’s medicinal use — as well as for more research into the drug’s long-term effects. “There’s a fair amount of science behind it,” Casarett says. “Those are medical benefits that people in the medical marijuana world — including advocates and patients — really take seriously.”

SARASOTA COUNTY — In November – when Florida’s medical marijuana amendment came up two points short of the 60 percent approval that would give it the force of constitutional law – AltMed LLC was forced to confront an uncomfortable truth.

Bhang Corporation makes and markets cannabis-infused chocolates and is working on a deal to produce more traditional medical delivery systems, such as transdermal patches with AltMed LLC of Sarasota.Photo provided by Bhang Corporation.

With no backup plan, the Sarasota County-based startup had become somewhat of an orphan: a would-be marijuana provider in a state that may or may not have a full-fledged medical program by 2018.

“We came in and sat down and had a little pity party for three or four hours, because we had never really planned for that,” said Michael Smullen, co-chairman of the board at AltMed, which now occupies an artfully decorated former showroom for granite countertops and floors in eastern Sarasota County. (A large production area is still sub-leased for granite work, but the eventual plan is to use that space to process and package cannabis products.)

During the run-up to the Amendment 2 vote, and in anticipation of an even sooner shot at one of five state licenses to make and process a non-euphoric extract used to treat epilepsy, AltMed had been recruiting key personnel. Within the office, the company now employs a medical director, an accountant, a lawyer, an organic chemist and an expert at growing high-value marijuana while following all the rules and regulations evolved in the 23 states where it is legal.

AltMed executives will decide this month whether to submit an application to grow, process and sell the extract — an effort that would provide good experience, and might grandfather the Sarasota County company into a potential future where there is more broad-based legal production in the Sunshine State.

But is not a way to make money.

Following the amendment’s defeat, the question on that financial front became: “How can we do something that provides revenues before Florida passes a law, without all of us going to jail?” said CEO David P. Wright, Smullen’s fellow founder.

The answer has been to create a careful corporate structure and use it to invest in two states that already have solid, ongoing medical marijuana programs. Wright said there is a constant flow of deals like this for companies like AltMed with the capital to invest. The real issue was trying to choose quality projects that put the company in league with other players that share its emphasis on marijuana as medicine.

Smullen, who became senior vice president of sales and marketing at a high-flying Nasdaq-traded bio-pharmaceutical firm, felt firsthand the agony of raising a daughter who experienced epileptic seizures.

He became a convert to the value of marijuana as a potential balm when he watched CNN documentaries on the subject by Dr. Sanjay Gupta in late 2013. Marijuana also has been shown to alleviate the fatigue and loss of appetite caused by chemotherapy, to reduce the tremors experienced by those with Parkinson’s disease. and to reduce pain — and possibly even the swelling — of arthritis.

Smullen had found an early ally in this vision to grow medical marijuana in Bill Petron, a friend and Ontario entrepreneur who owns a successful farm and construction equipment business.

To round out his team, Smullen turned to Wright, who had worked at the same biopharmaceutical firm and who also retired early to Sarasota.

With plenty of well-heeled friends, AltMed has found it relatively easy to raise more than $5 million from outside investors. The company plans to seek a like amount in the near future, Wright said.

“While these things are not cheap to do, they are going to have returns that are very, very rapid, and that is what we are looking for right now” Wright said. “We are looking to generate cash flow.”

Before the end of 2015, the cash should be flowing from a large indoor growing and processing plant in the small town of Coolidge, Arizona. With 60,000 square feet of growing space, the building will be one of the largest, if not the largest, in Arizona.

The operator, Agronomy Innovations, expects to begin moving plants into the building within a few weeks, and to be harvesting 100 pounds or more of usable cannabis leaves and buds per month by the end of the year.

AltMed will use its new status as a significant industry participant to make and market new lines of cannabis products, including edibles and a transdermal patch designed to deliver the active ingredients from marijuana into the blood stream through contact with the skin.

Meanwhile, discussions also are underway for a similar growing/processing venture in Colorado.

Because Florida has no marijuana program, being based in the state and working in others where cannabis is legal has its own built-in risks that must be carefully managed.

“For those willing to take a risk in the industry, the path will undoubtedly be encumbered with traps putting investors in imminent danger of running afoul with the law,” said David Welch, whose Los Angeles law firm specializes in business aspects of the medical marijuana industry. “Investors still have a misconception that marijuana is legal, when in reality it remains illegal under federal law. That said, an investor who can commit for a long term has the potential to reap significant returns when the law changes, while at the same time avoiding substantial legal implications.”

It is 113 degrees in the shade on a recent weekday in Coolidge, Arizona, as Ray Helbe — driving around in his car — explains how he made the transition from straitlaced NASA aerospace engineer to indoor marijuana specialist.

Like Smullen, a situation within Helbe’s own family changed the way he viewed the drug.

His wife, Danielle, became ill with breast cancer, which spread to her lymph nodes. Their son Nathan, 26, started making and providing her with a thick brown marijuana extract known as “Rick Simpson Oil,” which can be taken orally.

The medicine helped Danielle make it through both radiation and chemotherapy. While making absolutely no claim that marijuana is a cure, the family happily reports that Danielle is now cancer-free.

“She had no bad days when she was going through her treatment,” Helbe said. “It really opened my eyes.”

The father-and-son team got involved in helping others build three different marijuana-growing operations in Arizona, which has had a medical marijuana program in place since 2012.

Along with an old Marine Corps friend who now lives in Phoenix, the Helbes then decided to go into business themselves. Ray Helbe went all-in, cashing his 401(k) to convert a vacant 33,000-square foot building within the city limits of Coolidge into an ultra-modern, high-capacity marijuana operation with growing space on two levels.

While outsiders might consider Coolidge to be in the middle of nowhere, Ray Helbe notes that it is conveniently halfway between Phoenix and Tucson, Arizona’s two largest cities.

The Agronomy Innovations team expects to deliver its first crops before the end of the year. Because they are making concentrates, they can use more of the marijuana plant than if they were just selling the cured flower buds for smoking. Helbe figures he could eventually produce 1,000 pounds per month of usable plant material.

Cutting in AltMed for 15 percent ownership was a win-win. It will allow the Helbes’ company to ramp up faster and utilize the highest of high-technology gear.

“Everything can be checked on your smartphone,” Helbe said. “I can check relative humidity. I can add CO2 to a room.”

Once the Coolidge operation starts delivering plant material, the plan is for AltMed to process it and refine it into medicines, including the active ingredient in its transdermal patch.

Back at the former granite showroom in Sarasota County, Wright pulls three small product containers carrying the logo “Bhang” out from his desk drawer, carefully noting to his visitor as he does so that the containers are empty.

Bhang Corp.’s brand name already has become well known in medical marijuana circles for cannabis-infused chocolates, vaporizer pens and sprays. The company is actively producing and marketing products in six states, and will be operating in nine by the end of the year, Bhang CEO Scott Van Rixel says.

“Bhang has asked us to be their medicinal discovery arm,” Wright told the Herald-Tribune.

Van Rixel confirmed the arrangement, saying his company approached AltMed because of Wright’s and Smullen’s pharmaceutical product development experience.

“You get into the patches, pills, inhalers, nebulizers, tinctures,” Van Rixel said. “Things a doctor would see as more comfortable than saying, ‘Eat two cookies and call me in the morning.’”

AltMed hired an organic chemist to come up with what it feels is a more effective transdermal delivery system than those already on the market. Arizona medical marijuana patients will be the first to try them out.

For the Sarasota County company, the experience gained in Arizona and Colorado may bring benefits that can be translated back into the company’s home state as well.

It is very likely that the same group that promoted the medical marijuana amendment in 2014 will be back on the ballot in November 2016 with a very similar measure.

If they succeed, that would mean Florida, the third-most populated state in the nation, would become a multibillion-dollar market for cannabis, and particularly for easy-to-use products like AltMed’s patch.

“It’s a smart move for somebody who has eyes on going for a license of their own in a new state,” said industry consultant Kris Krane, managing partner of 4Front Advisors.

CHICAGO — Medical marijuana has not been proven to work for many illnesses that state laws have approved it for, according to the first comprehensive analysis of research on its potential benefits.

The strongest evidence is for chronic pain and for muscle stiffness in multiple sclerosis, according to the review, which evaluated 79 studies involving more than 6,000 patients. Evidence was weak for many other conditions, including anxiety, sleep disorders, and Tourette’s syndrome and the authors recommend more research.

Medical marijuana has not been proven to work for many of the illnesses state laws have approved it for, according to the first comprehensive analysis of research on its purported benefits published Tuesday. The Associated Press.

The analysis is among several medical marijuana articles published Tuesday in the Journal of the American Medical Association. They include a small study suggesting that many brand labels for edible marijuana products list inaccurate amounts of active ingredients. More than half of brands tested had much lower amounts than labeled, meaning users might get no effect.

Highlights from the journal:

THE ANALYSIS

The researchers pooled results from studies that tested marijuana against placebos, usual care or no treatment. That’s the most rigorous kind of research but many studies found no conclusive evidence of any benefit. Side effects were common and included dizziness, dry mouth and sleepiness. A less extensive research review in the journal found similar results.

It’s possible medical marijuana could have widespread benefits, but strong evidence from high-quality studies is lacking, authors of both articles say.

“It’s not a wonder drug but it certainly has some potential,” said Dr. Robert Wolff, a co-author and researcher with Kleijnen Systematic Reviews Ltd., a research company in York, England.

Independent laboratory testing for THC, marijuana’s leading active ingredient, found accurate amounts listed on labels for just 13 of 75 products. Almost 1 in 4 had higher amounts than labeled, which could cause ill effects. Most had lower-than-listed amounts. There were similar findings for another active ingredient. Products were not identified by name.

Johns Hopkins University researcher Ryan Vandrey, the lead author, said he was surprised so many labels were inaccurate. The researchers note, however, that the results may not be the same in other locations. READ MORE »

TALLAHASSEE — Orlando trial lawyer John Morgan has written a $150,000 check to jump-start an effort to get a medical-marijuana initiative back on the ballot in 2016.

United for Care — the political group behind the proposal — started hiring petition-gatherers to ensure the group does not get caught playing catch-up again.

Garnering more than 58 percent of the vote last November, a medical-marijuana initiative fell just short of the 60 percent approval required for constitutional changes. Morgan, who spent at least $5 million on the effort last year, says he is determined to give voters another stab at a revised version. Supporters hope heavier voter turnout for the presidential election will push the pot initiative above the 60 percent threshold.

United for Care campaign manager Ben Pollara said he thinks the group will need about $3 million to cover the costs of professional petition-gatherers and legal fees to get the initiative on the ballot. Pollara said he plans to have the paid workers fanned out statewide by July 1.

Pollara needs to turn in 683,149 valid petition signatures to the Department of State by Feb. 1 to get on the ballot. First, the group has to submit 10 percent of those petitions to the Florida Supreme Court to trigger a review of the revamped initiative, now entitled “Use of Medical Marijuana for Debilitating Conditions.”

WASHINGTON — Since the 1970s, advocates of an aggressive drug war have maintained that any liberalization of drug laws would “send the wrong message” to kids and increase adolescent drug use. This claim has been asserted repeatedly particularly in the debate over medical marijuana laws.

But there’s an ever-growing body of peer-reviewed research suggesting otherwise, and the latest such study comes from a group of researchers at Columbia University and elsewhere in this week’s journal of Lancet Psychiatry.

The authors analyzed 24 years of state-level survey data from the Monitoring the Future Survey, a large annual survey of 8th, 10th and 12th-graders in the U.S. The data included interviews with more than 1 million respondents, which the authors crunched to determine two things: first, is teen marijuana use higher in states that have medical marijuana laws? And second, did the passage of these laws cause increase teen use in subsequent years?

Here’s what they found: first, teen use is indeed higher in states with medical marijuana laws than in those without: “States that had ever enacted a medical marijuana law up to 2014 had higher prevalence of adolescent marijuana use than did other states.” Overall, teens in states with medical marijuana laws are about 27 percent more likely to use marijuana regularly than those in states without marijuana laws.

But crucially, this higher rate of use doesn’t seem to be linked to the passage of those medical marijuana laws. Controlling for various individual-level, school-level and state-level risk factors, kids were no more likely to report marijuana use after the enactment of medical marijuana laws than they were before it. “The risk of marijuana use did not significantly change after passage of a medical marijuana law,” the authors found. In fact, they even observed a statistically significant decrease in use among eight graders after the passage of medical marijuana bills.

So, wait: if medical marijuana laws aren’t causing increased teen pot use, then why are use rates higher in medical marijuana states? Probably due to other, unseen factors, like cultural factors, or overall attitudes toward drug use. “State-level risk factors other than medical marijuana laws could contribute to both marijuana use and the passage of medical marijuana laws, and such factors warrant investigation,” the authors wrote.

The study, compiled with the body of research that’s come before it, provides new evidence that medical marijuana laws aren’t causing increased teen use: “these findings, consistent with those from earlier studies, provide the strongest empirical evidence yet that medical marijuana laws do not account for increased use of marijuana in U.S. adolescents,” the researchers write.

When it comes to the frequent claims that medical marijuana will “send the wrong message to kids,” the authors don’t mince words: “Our study findings suggest that the debate over the role of medical marijuana laws in adolescent marijuana use should cease, and that resources should be applied to identifying the factors that do affect risk.”

DENVER – Even in one of the country’s most marijuana-friendly states, smoking pot off the job and away from work can still get an employee fired.

That was the unanimous conclusion of the Colorado Supreme Court on Monday, in a closely watched workplace lawsuit involving a customer service worker who uses medical marijuana to help soothe the painful spasms he has suffered since a car accident left him paralyzed. The worker, Brandon Coats, was fired from Dish Network in 2010 after testing positive for marijuana in a random drug test.

The court’s decision was a blow to marijuana advocates, who have consistently seen court rulings go against them, with judges in Colorado and elsewhere saying that companies have the right to create their own drug policies. The loss by Coats highlights the limits of marijuana legalization at a time when more states are approving medical or recreational uses of a drug that is still outlawed as a Schedule I controlled substance by the federal government.

“The federal government has in many ways the last say,” said Sam Kamin, a law professor at the University of Denver who studies legal issues swirling around marijuana’s growing place in society. “As long as that federal prohibition is in place, the states can only do so much.”

Twenty-three states allow medical marijuana, and Colorado is one of four that have legalized the drug’s recreational use for adults. But Colorado is confronting a backlash from two neighboring states, sheriffs, rural property owners and a hotel company who argue in separate lawsuits that Colorado’s network of state-licensed marijuana retailers and dispensaries is illegal, bad for property values and public safety, and should be dismantled.

In another backlash, dozens of cities in Colorado and Washington state have banned marijuana dispensaries from their limits.

Despite those conflicts, the regulated marijuana industry has become a presence here. There are marijuana-themed yoga classes, cooking seminars and gallery events, and the state is taking in millions in tax dollars from marijuana sellers. Federal law enforcement officials have largely allowed states to proceed with their efforts to regulate medical and recreational marijuana.

But the federal prohibitions on the drug have made it difficult for dispensaries and regulated growers to get bank accounts or lines of credit, and have forced marijuana businesses to pay abnormally high tax bills. Marijuana advocates said the court’s ruling Monday highlighted the legal gray areas where marijuana intersects with employment law and other matters, such as custody disputes and housing cases.

After more than a year of delays, the Florida Department of Health on Wednesday will begin accepting applications for five geographically distributed licenses to grow non-euphoric marijuana, process it into a concentrated oil and market it to epileptics and people with cancer.

It is a process that was expected to get underway last summer, but was prevented when various would-be applicants made legal challenges to the rules.

How many applicants there will be is unknown, but the number has likely dwindled from what it would have been a year ago.

At that time, companies were hooking up with Florida nurseries qualified under the law with the aim off getting a license in advance of the potential passage of the proposed medical marijuana amendment 2, which received 58 percent of the popular vote — 2 percentage points less than the 60 percent required for ratification.

The applications must be made by Florida nurseries that have been in existence for 30 years or longer and have 400,000 or more plants under cultivation.

“Ninety-two nurseries are eligible to apply,” said David Kotler, a Boca Raton attorney who specializes in medical marijuana legal consulting. “The scuttlebutt was 15 were probably capable of applying. Frankly I think the number is going to be a little less.”

The South Florida license covers the largest portion of Florida’s population. Using conservative estimates, Kotler and a client figured they should only count on 1,400 monthly clients. “The expected revenue was pretty good after ramp-up, but start-up costs were high,” he said.

Overall, it will cost each successful license winner more than $2 million just to set up shop. Submitting an application requires a $63,000 nonrefundable fee. If successful in winning a license, the enterprise must post a $5 million bond, which costs $50,000 to $300,000 per year to maintain. Building an indoor grow operation could cost $1.75 million or more. The processing plant and lab together would bring that total to a minimum of $2.25 million.

Officials at Sarasota County’s AltMed LLC, which in the past has described a working relationship with a qualified Sarasota County nursery, on Monday declined to comment on whether they would be part of an application by July 8, when the state’s narrow window will close.

The health department now claims it could have the extract in the hands of patients by the end of 2015, but potential suppliers say spring 2016 would be more likely.

SEATTLE — Dozens of government officials and researchers from a half-dozen U.S. states and a few countries that have legalized marijuana or are at least thinking about it are gathering in Washington state this week for meetings focused largely on one question: How do we know if it’s working?

Organizers say it’s crucial to get a better handle on what data are being collected about the impacts of legalization and to consider what further research is needed. Otherwise, it’s going to be tough to quantify how this major social policy change is affecting everything from school suspension rates to traffic fatalities.

“The real purpose … is to be sure we’re doing the best we can to evaluate the impacts,” said John Walsh with the Washington Office on Latin America, a social-justice organization sponsoring the conference along with the Washington state chapter of the American Civil Liberties Union. “We want to learn from the pioneers for the pioneers, but be more systematic about what we know and what we still need to learn so the jurisdictions that are coming next can avoid mistakes and do an even better job.”

The conference, held in Seattle and Spokane, has drawn officials from the legal pot states of Washington, Colorado, Oregon and Alaska, as well as Vermont and California, which is expected to vote on legalization next year. Other attendees have come from Jamaica, Mexico, Colombia and Uruguay, the only country that has legalized the adult use of marijuana.

Washington’s legal pot law, passed in 2012, included a requirement that the state conduct a cost-benefit analysis, and some data are being tracked and analyzed, including on marijuana-involved traffic stops, marijuana-related calls to the state poison center and admissions to addiction treatment centers. Surveys provide a good idea of students’ attitudes toward and use of marijuana, and the University of Washington is assessing marijuana-related parenting behaviors to better inform prevention efforts.

In Colorado, the only other state where legal, recreational pot sales have started, officials are also tracking marijuana-related school suspensions, hospital room marijuana mentions, impaired driving cases and poison control calls.

But there are shortcomings, too, as Dr. Kathy Lofy, Washington’s top public health officer, wrote in notes for the conference. Health-risk behavior surveys are of limited use when it comes to estimating marijuana use in small areas or among ethnic groups; it’s not clear how to identify marijuana-related car accidents; there’s limited data available on long-term marijuana use; and there’s no national consensus yet about how to survey people about changing ways of using pot, such as by vaporizing it or eating it.

The conference also provided a chance for attendees to chat about what has and hasn’t worked well in Washington, Colorado and Uruguay.

Dr. Jay Butler, the public health director in Alaska, which joined Oregon in voting to legalize pot last year, said in response to a conference questionnaire that he wanted to learn more about the legal markets that are already up and running. And Conrad Gregory, the chief economic development consultant for California Lt. Gov. Gavin Newsom, said he was interested in ideas for how to incorporate the growers in that state’s famed “Emerald Triangle” into any statewide legal marijuana industry, should California vote to legalize.

Dr. Wendel Abel, who serves on the agency that has been set up to regulate medical marijuana in Jamaica, noted that governments need to carefully craft messages for young people that just because marijuana’s legal doesn’t mean it’s not harmful — something public health advocates said Washington state failed to do before legal sales began.

But he said he was also struck by the economic possibilities on seeing that recreational sales in Washington and Colorado have topped a combined $500 million, with tens of millions of dollars in tax revenue coming into state coffers.

“You’re able to divert funds that would have gone into the black market,” he said. “This is attractive.”

Guy Lindblom picks unnecessary leaves from mature cannabis plants so they can concentrate more of their energy into the flowering buds where the medicinal chemicals are produced at a greenhouse in Otsego, Minn. The crop is coming in at Minnesota Medical Solutions, one of two manufacturers who will be supplying the state’s medical marijuana. (Glen Stubbe/Star Tribune via AP)

WASHINGTON — The Republican-controlled House voted Wednesday to prevent the federal government from blocking state laws that permit the use of medical marijuana.

But lawmakers narrowly declined to direct the Justice Department not to interfere with states like Colorado and Washington that permit the recreational use of marijuana.

The 242-186 vote on medical pot was a larger margin than a tally last year, when the House first approved it as part of a bill funding the Justice Department. Wednesday’s vote was to renew the pro-pot language as part of a bill providing funding for the coming fiscal year.

Most Republicans opposed the idea and the Senate is controlled by that party this year, so the outcome could still be reversed. But Senate advocates of medical marijuana won a test vote in the Appropriations Committee last month.

On Wednesday, 67 Republicans, including libertarian-minded lawmakers such as Thomas Massie of Kentucky, combined with all but a handful of Democrats in support of states that allow doctors to prescribe pot for medical uses, such as improving the appetites of cancer patients undergoing chemotherapy.

Almost half the states allow medical marijuana, which remains an illegal drug under federal law. But the federal government has adopted a hands-off approach to states that have adopted lenient marijuana laws. The Justice Department has issued guidance to governors in such states — including the four that have enacted laws permitting pot possession for recreational use — that it won’t challenge those laws so long as marijuana is tightly regulated.

The government is instead focusing on preventing distribution to minors and keeping pot profits from going to organized criminal enterprises. Still, marijuana is a Schedule I drug under a landmark 1970 drug law, meaning the government deems it to have “no currently accepted medical use” and a “high potential for abuse.”

The Treasury Department has also issued guidance intended to clarify that financial institutions can offer services to businesses that dispense marijuana, though industry advocates say most banks are still reluctant to do so for fear of prosecution.
The amendment to allow recreational pot use, offered by conservative Rep. Tom McClintock, R-Calif., was rejected by a surprisingly narrow 222-206 vote. McClintock’s measure had less GOP support and more Democratic opposition than did the amendment on medical marijuana.

“This is not an argument for or against marijuana,” McClintock said. “This strictly involves the rights of citizen in various states to regulate commerce that occurs entirely within their own borders.”

Voters in Alaska and Oregon last year approved ballot measures legalizing marijuana, bringing the number of states permitting legal pot possession to four.

Opponents say marijuana remains dangerous even as laws get more lenient.

“A study recently found that even casual users experience severe brain abnormalities … and that pot smoking leads to a loss of ambition, to lower IQs, and that it impairs attention, judgment, memory and many other things,” said Rep. John Fleming, R-La.

New Leaf Enterprises in Seattle. Washington’s medical marijuana growers have sought legislative validation for their businesses. (Photo by David Ryder for The New York Times)

SEATTLE — With Washington state overhauling its medical marijuana law, Seattle Mayor Ed Murray says the city is planning to shutter dozens of dispensaries.

Murray on Tuesday announced plans to require a new special business license for marijuana establishments, akin to those required for taxi operators and pawn shops. Under the mayor’s plan, the businesses will be required to obtain the licenses by July 2016.

But just as the state’s new medical marijuana law gives priority in licensing to dispensaries that were in operation before Jan. 1, 2013, so does Murray’s proposal. Seattle officials say that by their tally, 54 of the city’s 99 medical marijuana storefronts opened after that date or have been operating without a city business license.

Murray’s office says those businesses won’t be getting the special license and need to shut down. The rest will be allowed to remain open long enough to see if they wind up being permitted by the state.

“It is time to ensure that everyone plays by the same rules,” Murray said. “We’re strengthening the recreational marijuana market and creating safer, more consistent access for those who rely on medicinal products.”

Earlier this year, state lawmakers passed a new medical marijuana law as they tried to reconcile the tension in the marketplace since voters in 2012 approved a measure legalizing recreational use of pot.

The proliferation of green-cross medical dispensaries had long been a concern for police and other officials who said they were a masquerade for black-market sales. Some proprietors of the new, state-licensed recreational pot businesses — saddled with higher taxes — called them unfair competitors.

Among the new state medical marijuana law’s many provisions, it creates a voluntary registry of patients and, beginning next year, eliminates what have become in some cases large, legally dubious “collective gardens” providing cannabis to thousands of people.

Instead, those patients will be able to purchase medical-grade products at legal recreational marijuana stores that obtain an endorsement to sell medical marijuana, or they’ll be able to participate in much-smaller cooperative grows, of up to just four patients.

Washington in 1998 became one of the first states to approve the use of marijuana for medical purposes.